Prevalence of chronic illness in pregnancy, access to care, and health care costs: implications for interconception care.
OBJECTIVE
Access to health care after pregnancy is especially important for pregnant women with chronic illness. The purpose of our study was to describe the prevalence of chronic illness in pregnant women and factors affecting the receipt of ongoing care.


METHODS
We conducted a cross-sectional analysis of 6,294 women between 19 and 45 years of age from the Medical Expenditure Panel Survey (MEPS). Chronic illness was defined using aggregate clinical classification codes in the MEPS. Women were divided into 4 groups: pregnant and currently not pregnant, with and without chronic illness. We analyzed group differences in demographic variables, socioeconomic status, and access to health care. We also estimated inpatient, outpatient, emergency room, and pharmacy expenditures for the 4 study groups. All analyses accounted for the complex survey design of MEPS.


RESULTS
Overall, 27% of pregnant women and 39% of nonpregnant women reported a chronic illness. There were no differences in race/ethnicity, poverty, or health insurance status between pregnant women with and without chronic illness. Women with chronic illness were more likely to have a usual source of care. Among pregnant women, the presence of a chronic condition did increase out-of-pocket expenditures, but did not increase total average health care expenditures, even after adjusting for other characteristics.


CONCLUSIONS
Pregnant women with chronic illness were similar to pregnant women without chronic illness in terms of access to care and total health care costs. Further research is needed to determine whether these similarities persist after delivery, given the relatively high prevalence of women with chronic illness who are of childbearing age.
Chatterjee
Sharmila
S
Center for Health Quality, Outcomes and Economic Research (CHQOER), ENRM VA (152), Bedford, Massachusetts, USA. sharmcha@bu.edu
Kotelchuck
Milton
M
Sambamoorthi
Usha
U
D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D016742:Preconception Care / Q000191:economics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000191:economics*; D055815:Young Adult